Journal of Clinical and Investigative Dermatology
Case Report
Mycosis Fungoides Presenting After Dupilumab Therapy: Case Report and Systematic Review
Visconti M1, Teklehaimanot F2, Tan V2 and Fivenson D1,3*
1Department of Dermatology, St Joseph Mercy Hospital Ann Arbor,
Ypsilanti, Michigan
2Michigan State School of Osteopathic Medicine, East Lansing, Michigan
3Fivenson Dermatology, 3200 W Liberty Rd, Suite C5, Ann Arbor, Michigan
Submission: 24 March, 2023
Accepted: 04 April, 2023
Published: 02 May, 2023
*Address for Correspondence
Fivenson D, Fivenson Dermatology, 3200 W Liberty Rd, Suite C5,
Ann Arbor, Michigan 48103; USA; Phone: 734-222-9630; E-mail:
dfivenson@fivensondermatology.com
Copyright: © 2023 Visconti M, et al. This is an open access article
distributed under the Creative Commons Attri-bution License,
which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Keywords: Atopic dermatitis; Cutaneous T cell Lymphoma;
Cytokine; Mycosis Fungoides; Cutaneous T cell Lymphoma; IL-13, IL-4;
IL-13Rα1 and IL-13Rα2
Abstract
Introduction: Several reports have been made associating
dupilumab therapy for atopic dermatitis (AD) with the development of
mycosis fungoides (MF) and other cutaneous T cell lymphomas (CTCL)
Methods: A new case report and systematic review were
conducted to identify reports of MF/CTCL after minimum 6 weeks of
dupilumab therapy between January 2021 and March 2023.
Results: 28 patients from 18 publications (including our case) were
identified, averaging 17.4 years of AD duration with 18.5 weeks of
dupilumab therapy prior to MF/CTCL diagnosis. MF/CTCL presented
as 6 stage I, 4 stage II, 3 stage III, 4 stage IV, 3 Sezary syndrome, 6
large cell transformation, 2 peripheral T cell lymphoma (PTCL) and 1
with coexisting Hodgkin’s lymphoma. There were 13 females, 15 males,
and included 2 African-Americans, 4 Asians, and 22 Caucasians. 11
patients had initial improvement on dupilumab.
Conclusion: Clinical unmasking of MF/CTCL or de novo
lymphomagenesis as the mechanism in these patients is unknown.
Increased IL-13 and/or inhibition of reactive T cells through IL-4/IL-
13 blockade are possible mechanisms of action. Awareness of this
phenomenon during AD treatment and close follow-up and biopsy of
non-responders or those who develop new morphologies is important.